Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, GR54642, Thessaloniki, Greece.
2nd Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
BMC Nephrol. 2020 Jul 15;21(1):276. doi: 10.1186/s12882-020-01930-6.
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a relatively novel class of oral medications for the treatment of Type 2 DM with a generally acceptable safety profile. However, these agents have been associated with rare events of a serious and potentially life-threatening complication named euglycemic diabetic ketoacidosis (euDKA). euDKA is not identical with the typical diabetic ketoacidosis, as it often presents with serious metabolic acidosis but only mild to moderate glucose and anion gap elevation.
We report a case of a 51-year old female with Type 2 DM treated with an SGLT-2 inhibitor, developing severe metabolic acidosis with only mild blood glucose elevation after a routine surgery. A careful evaluation of involved factors led to the diagnosis of euDKA, followed by cautious application of simple therapeutic measures that resulted in complete restoration of acidosis and glycemic control in less than 48-h.
Euglycemic ketoacidosis is a rare but rather serious complication of SGLT-2 inhibitors use, often with a multifactorial etiology. Its atypical presentation requires a high level of awareness by physicians as early recognition of this complication can quickly and safely restore acid-base balance.
钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂是一类新型的口服药物，用于治疗 2 型糖尿病，具有可接受的安全性。然而，这些药物与一种罕见的严重且潜在危及生命的并发症有关，即血糖正常的糖尿病酮症酸中毒（euDKA）。euDKA 与典型的糖尿病酮症酸中毒不同，因为它常表现为严重的代谢性酸中毒，但仅有轻度至中度血糖和阴离子间隙升高。
我们报告了一例 51 岁女性患者，患有 2 型糖尿病，接受 SGLT-2 抑制剂治疗，在常规手术后出现严重代谢性酸中毒，仅轻度血糖升高。对相关因素进行仔细评估后，诊断为 euDKA，随后谨慎应用简单的治疗措施，不到 48 小时内酸中毒和血糖控制完全恢复。
血糖正常的糖尿病酮症酸中毒是 SGLT-2 抑制剂使用的一种罕见但较为严重的并发症，常为多因素病因。其非典型表现需要医生高度警惕，因为早期识别这种并发症可以快速、安全地恢复酸碱平衡。
